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Clinical Practice & Epidemiology in Mental Health, 2014, 10, 59-66 59
1745-0179/14 2014 Bentham Open
Open Access
Does Parental Divorce Increase Risk Behaviors among 15/16 and 18/19
year-old Adolescents? A Study from Oslo, Norway
Henok Zeratsion1,*, Cecilie B. Bjertness1, Lars Lien2, Ole R. Haavet3, Madeleine Dalsklev4,
Jon A. Halvorsen5, Espen Bjertness1,6 and Bjørgulf Claussen1
1Institute of Health and Society, University of Oslo, Box 1130 Blindern, 0318 Oslo, Norway; 2National Center for Dual
Diagnoses, Innlandet Hospital Trust HF 2312 Ottestad, Norway; 3Department of General Practice, Institute of Health
and Society, University of Oslo, Norway; 4Institute of Psychology, University of Oslo, Box 1130 Blindern, 0318 Oslo,
Norway; 5Department of Dermatology, Oslo University Hospital Rikshospitalet, Faculty of Medicin, Norway; 6Tibet
University Medical College, Lhasa, Tibet, China
Abstract: Background: Several studies have reported an increase in risk behaviors among adolescents after experience of
parental divorce. The aim of the study was to investigate whether parental divorce is associated with risk behavior among
adolescents independent of mental health problems, first when early divorce was experienced, and second after experience
of late parental divorce. Method: One prospective (n=1861) and one cross-sectional study (n=2422) were conducted using
data from two Young-HUBRO surveys in Oslo, Norway. All 15/16 year-old 10th grade students who participated in the
first survey in the school year 2000/01 were followed-up in 2004 when they were 18/19 year-olds. The follow-up rate was
68%. The prospective study investigated the influence of late parental divorce that occurred between the age of 15/16 and
18/19. In the cross-sectional study we focused on early parental divorce that occurred before the participants were 15/16
year-old. R esults: In the prospective study we could not discern a significant association between experiencing late paren-
tal divorce and an increase in risk behaviors among 18/19 year-old adolescents. In the cross-sectional study parental di-
vorce was significantly associated with cigarette smoking and using doping agents. Conclusion: Parental divorce that oc-
curs when the children of divorced parents are 15/16 year-old or younger is associated with an increase in cigarette smok-
ing and use of doping agents. However, no evidence of significant association is found between experience of late paren-
tal divorce and risk behaviors in late adolescence.
Keywords: Adolescents, internalized and externalized mental health problems, parental divorce, risk behaviors.
INTRODUCTION
Experiencing parental divorce has been associated with
an increased likelihood of exhibiting psychological, behav-
ioral and social problems among children of divorced parents
[1-4]. Several prospective and cross-sectional studies among
adolescents found that an increase in risk behaviors includ-
ing cigarette smoking, alcohol intake and substance abuse
was associated with experience of parental divorce [5-10].
However, some studies reported that the adverse effect of
parental divorce was found only among boys and not among
girls [11, 12].
A longitudinal study from the USA found that adoles-
cents who experienced parental divorce in their early or late
adolescence had higher rates of cigarette smoking when
compared with their peers from continuously married parents
[3]. According to a Norwegian study [4] and three European
studies [6, 7, 13], adolescents who lived with both parents
drank less [10, 14] and smoked less cigarettes [15] than their
peers who lived in other types of families. In investigations
of the long-term effect of parental divorce, alcohol
*Address correspondence to this author at the Institute of Health and Soci-
ety, University of Oslo, Box 1130 Blindern, 0318 Oslo, Norway;
Tel: +47 4128 3758; Fax: +47 2285 0610;
E-mails: h.t.zeratsion@medisin.uio.no or hzeratsion@yahoo.com
consumption was found to be significantly higher among
adults [16] and women [17] who experienced parental di-
vorce during childhood or adolescence than among their
counterparts without such experience. Parental divorce dur-
ing childhood or adolescence was found to have been sig-
nificantly associated with lifetime alcohol dependence [9,
10, 18].
There is an indication of an indirect effect on risk behav-
iors of parental divorce that is mediated by mental health
problems. In a study from Norway, there was an evidence of
significant effect of parental divorce on the offspring’s men-
tal health problem [19] which in turn was associated with
cigarette smoking, alcohol consumption and illicit substance
use in children and adolescents [20]. In our previous pro-
spective study of the same study population, however, we
found non-significant association between experience of late
parental divorce and mental health problems among young
people in their late adolescence [21].
It seems that there are few empirical studies that have ex-
amined several risk behaviors at the same time among ado-
lescents of divorced parents. The present study is expected to
contribute towards addressing this scarcity in literature by
investigating the association of parental divorce with four
types of risk behaviors including cigarette smoking, snus
60 Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 Zeratsion et al.
use, frequent alcohol drinking, and use of doping agents.
Public health implications of parental divorce also make the
present study timely. A previous research elucidated a con-
siderable public health effect when it found an increased risk
for cancer at tobacco-related and alcohol-related sites among
0-70 year-old offspring of divorce [22].
We wanted to test two hypotheses with two designs:
1. Compared to their peers from continuously married par-
ents, 18/19 year-old adolescents have higher risk for in-
creased risk behaviors after experience of late parental
divorce that occur between 15/16 and 18/19 years of age
(the prospective study).
2. Adolescents experiencing parental divorce when th ey are
15/16 year-old or younger have higher level of risk be-
haviors compared with their peers whose parents were
continuously married at 15/16 years of age (the cross-
sectional study).
MATERIALS AND METHODOLOGY
Data Source and Selection of participants
All members in a cohort of 15/16 years-old 10th grade
students in the city of Oslo (n=4273) were invited to partici-
pate in the baseline survey of Young-HUBRO in their
school-year 2000/2001, and were followed-up three years
later. The response rate at the baseline and follow-up surveys
was 89% (n=3811) and 68%, respectively. Additional de-
scription of sampling in Young-HUBRO is available in an-
other article [23].
Self-administered questionnaires were primarily an-
swered in class room sessions. The questionnaire was sent by
post to 13% of the participants who were not present at
school at follow-up. Participants who stated parental marital
status was other than married/cohabitants or di-
vorced/separated in the first survey (n=191) and those who
stated inconsistent response in both surveys (n=55) were not
relevant for our study objective and were excluded from
analysis, giving a new baseline sample of Young-HUBRO
(n=3565). Among these, 1143 adolescents did not respond to
the question on marital status giving a usable sample of 2422
for the cross-sectional study. Since our focus was on late
parental divorce in the prospective study, we excluded the
530 adolescents who had experienced parental divorce be-
fore the age of 15/16 years and other 31adolescents whose
parental marital status at follow-up was other than mar-
ried/cohabitant or divorced/separated, giving a sample of
1861.
Explanatory Variables
Dichotomized into “continuously married” and “di-
vorced”, parental marital status was our main independent
variable. Continuously married was defined as parents of
adolescents who had never experienced divorce until time
of study in 2000/01 for cross-sectional study, and in 2004
for prospective study. Divorce that occurred between the
two surveys was termed “late parental divorce” while
“early parental divorce” was defined as all parental di-
vorces that occurred when the offspring was 15/16 year-old
or younger.
Potential confounders included gender, ethnicity, family
economy, social support, and internalized or externalized
mental health problems. Ethnicity was dichotomized into
“western” and “non-western” based on parents’ place of
birth. Family economy was dichotomized into “above aver-
age” and “average and below”, based on the statement “I
believe, relative to others in Norway, my family has: 1)
‘poor economy’, 2) ‘average economy’; 3) ‘good economy’;
or 4) ‘very good economy’.” Social support was created by
summarizing the response of two questions that focused on
availability of help: “How many persons outside your imme-
diate family are so close to you that you can rely on to get
help 1) if you have personal problems, 2) if you have practi-
cal problems (for example, school assignments)?” Those
who answered “0” or “1” for each of these two separate
questions formed the low social support category, and the
rest were grouped to form the high social support category.
This gave a cut-off point at 85th and 78th percentile of the
sample in the first and the second question, respectively. The
mean inter-item correlation value was 0.42, which is within
an optimal range for a scale with fewer than 10 items [24].
The number of people to rely on for help was used as a
proxy measure of social support as in other studies [25].
Internalized mental health problems were measured us-
ing the 10-item version of the Hopkins Symptoms Check
List (HSCL-10). The ten questions were asked to measure
the level of anxiety and depression symptoms during the
week preceding the date of survey. Ten items were rated on a
scale from 1 (no symptom) to 4 (much of the symptom). An
average score for all 10-items of 1.85 was used as cut-off
point to dichotomize the variable into “No internal mental
health problem” and “Have internal mental health problem”;
the second category was formed of scores greater than or
equal to 1.85 [26]. This cut-off point was used in other stud-
ies as a valid predictor of mental distress among adolescents
[27]. Reliability was high (Cronbach’s alpha = 0.88).
Externalized mental health problems were measured by
the 10 items of hyperactivity and conduct problems in the
Strengths and Difficulties Questionnaire [27, 28]. The study
participants answered as “not true” (0), “somewhat true” (1)
or “certainly true” (2), to the statements in each of the 10
items which gave scores from 0 to 20. The period of six
months preceding the survey date was the reference period
for self-reporting on externalized mental health. The cut-off
point was set at 90th percentile of the sample as in other stud-
ies [27, 29]. This dichotomized the variable into “no exter-
nalized mental health problem” (0) and “have externalized
mental health problem” (1). Reliability was alpha = 0.67.
Outcome Variables: Risk Behaviors
In the present study, risk behavior refers to life style ac-
tions related to the consumption or abuse of cigarettes, snus,
alcohol or doping agents. Each of these four risk behaviors
was studied separately as an outcome variable.
Cigarette Smoking
The question was “Do you smoke, or have you smoked?”
The response categories ‘Never’, and ‘Yes, but I have
stopped’ were recoded as “no”; and the remaining response
categories 3) ‘Yes, sometimes’ and 4) ‘Yes, every day’ were
Parental Divorce and Risk Behaviors Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 61
recoded as “yes”. For quitters, we did not have data on the
time they stopped smoking. Therefore, we could not know
whether smoking was quitted before or after parental divorce
occurred; thus, quitters were categorized in the non-smoker
group.
Snus
The variable “snus” was primarily used to describe the
moist powder tobacco placed under the lips and which does
not need for spitting. It is common in the Scandinavian re-
gion. As the question read “Do you use or have you used
snus or the likes?”, in addition to snus consumption, the
variable also refers to other tobacco forms consumed in the
mouth or those snuffed through the nose. The response cate-
gories ‘Never’ and ‘Yes, but I have stopped’ were recoded as
“no”; and ‘Yes, sometimes’ and ‘Yes, every day’ were
recoded as “yes”. Due to lack of data on time they stopped
using snus, those who quitted using snus or its variants were
grouped with respondents who had never used snus.
Frequency of Drinking
The question was “Approximately how often, during the
last year, have you been drinking alcohol?” The response
categories ‘4-7 times a week,’ ‘2-3 times a week, and ‘ap-
proximately once a week’ were recoded as “yes”; and the re-
maining categories ‘2-3 times a month,’ ‘Approximately once
a month,’ ‘A few times last year,’ ‘Did not drink alcohol last
year’, and ‘Have never had alcohol’ were recoded as “no”.
Doping Agents
The question was “Have you used doping agents?” The
response category ‘Never’ was recoded as “no”, and the re-
sponse categories ‘Yes, once’, ‘Yes, sometimes’ and ‘Yes, I
use it regularly’ were recoded as “yes”.
Missing Values
In our present cross-sectional study the sample included
only those who participated in both waves of Young-
HUBRO survey and who answered the question on parental
marital status. The missing values were in 32% of the par-
ticipants (n=3565) in the first Young-HUBRO survey. The
proportion of non-response was lower (27%) among western
than among non-western (42%) adolescents. The missing-
ness of response was random at the other independent vari-
ables.
Statistics
Pearson’s chi square test was used to study bivariate as-
sociations of parental divorce with other explanatory vari-
ables (Table 1) and with outcome variables (Table 2). We
fitted multivariate logistic regression models in a prospective
(Table 3) and a cross-sectional (Table 4) study to analyze the
impact of parental divorce on the risk behavior variables.
Only one risk behavior was included as a dependent variable
in each statistical model.
In the prospective study we analyzed the relation be-
tween late parental divorce and a change in risk behavior
over the follow-up period of three years. Taking the risk be-
havior at age 18/19 as the outcome variable, we controlled
for gender, ethnicity, family economy, social support, mental
health problems and the same risk behavior at age 15/16.
Adjusting for cigarette smoking at age 15/16, for example,
we investigated if the increase in the odds of cigarette smok-
ing from baseline to follow-up was higher among adoles-
cents who experienced late parental divorce than among their
counterparts from continuously married parents, independent
of cigarette smoking at baseline. Thus, the dependent vari-
able in the prospective study was made to be the change in
the odds of cigarette smoking in relation to a change in pa-
rental marital status during the follow-up time.
In the cross-sectional study, the odds of developing a risk
behavior among 15/16 year-old adolescents who experienced
parental divorce before age 15/16 was compared with that of
peers from continuously married parents. In addition to the
other independent variables, either intern alized- or externalized
mental health problem was controlled for in all regressions.
Ethics
Both the students and their parents gave their informed
consents. The study was approved by the Regional Commit-
tee for Medical Research Ethics in South East Norway.
RESULTS
In the prospective study, 5.9% of the adolescents had expe-
rienced parental divorce between 15/16 and 18/19 years of
age, while in the cross-sectional study, 21.9% had experienced
parental divorce when they were 15/16 year-old or younger.
Late parental divorce was associated with family economy
and with internalized mental health problems (Table 1). Early
parental divorce was more often experienced among western
children and adolescents, those reporting average and low
family economy, or internalized mental health problems.
Neither crude nor adjusted results showed significant asso-
ciation of late parental divorce with increase in odds of risk
behaviors over the follow-up period (Table 3). Adjustment for
mental health problems did not change this non-significant
association. In the cross-sectional design, crude OR showed
significant association of parental divorce with risk of ciga-
rette smoking and using doping agents (Table 4). This signifi-
cant association sustained even when the model was adjusted
for gender, ethnicity, family economy, social support and in-
ternalized or externalized mental health problems.
DISCUSSION
In our prospective study we found no evidence of signifi-
cant change in the odds of risk behaviors after experience of
late parental divorce between 15/16 and 18/19 years of age.
In the cross-sectional study it was found that 15/16 year-old
adolescents who experienced early parental divorce were
more likely to smoke cigarettes and use doping agents com-
pared to their peers whose parents were continuously married.
Thus, we do not have evidence from the prospective
study to support our first hypothesis of an increase in risk
behaviors after late parental divorce. Our second hypothesis
of higher levels of cigarette smoking and use of doping
agents among 15/16 year-olds who experienced parental
divorce before they were 15/16 year-old has been supported
by the results of the cross-sectional study.
62 Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 Zeratsion et al.
Table 1. Independent variables (vertical percentages) across late parental divorce experienced between 15/16 and 18/19 years of
age (n=109) in a prospective study, and across early divorce experienced before the adolescent became 15/16 year-old
(n=530) in a cross-sectional study of 18/19 year-old norwegian adolescents in 2004.
Prospective study (N=1861) Cross-sectional study (N=2417)
Independe nt
Variables Categories Frequency
(Vertical %)
Continuo usly#
Married
Late
Divorce
Frequency
(Vertical %)
Continuo usly##
Married
Early
Divorce
Male 838 (45.0) 793 (94.6) 45 (5.4) 1080 (44.7) 849 (78.6) 231 (21.4)
Gender
female 1023 (55.0) 959 (93.7) 64 (6.3) 1337 (55.3) 1038 (77.6) 299 (22.4)
Western 1608 (86.4) 1515 (94.2) 93 (5.8) 2127 (88.0) 1631 (76.7) **496 (23.3)
Non-western 246 (13.2) 230 (93.5) 16 (6.5) 280 (11.6) 249 (88.9) 31 (11.1)
Ethnicity
Missing 7 (0.4) 7 (100) 0 (0.0) 10 (0.4) 7 (70.0) 3 (30.0)
Average and below 420 (22.6) 381 (90.7) **39 (9.3) 658 (27.2) 432 (65.7) **226 (34.3)
Above average 1408 (75.7) 1340 (95.2) 68 (4.8) 1722 (71.2) 1421 (82.5) 301 (17.5)
Family economy
Missing 33 (1.7) 31 (93.9) 2 (6.1) 37 (1.6) 34 (91.9) 3 (8.1)
Low 157 (8.4) 149 (94.9) 8 (0.4) 217 (9.0) 164 (75.6) 53 (24.4)
High 1692 (91.0) 1591 (94.0) 101 (6.0) 2188 (90.5) 1711 (78.2) 477 (21.8)
Social support
Missing 12 (0.6) 12 (100) 0 (0.0) 12 (0.5) 12 (100) 0 (0.0)
No mental health
problems 1565 (84.0) 1482 (94.7) *83 (5.3) 2006 (83.0) 1586 (79.1) **420 (20.9)
Have mental health
problems 296 (16.0) 270 (91.2) 26 (8.8) 411 (17.0) 301 (73.2) 110 (26.8)
Internalized mental
health problems
Missing 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
No mental health
problems 1673 (89.9) 1576 (94.2) 97 (5.8) 2171 (89.8) 1695 (78.1) 476 (21.9)
Have mental health
problems 159 (8.5) 148 (93.1) 11 (6.9) 213 (8.8) 50 (23.5) 163 (76.5)
Externalized mental
health problems
Missing 29 (1.6) 28 (96.6) 1 (3.4) 33 (1.4) 29 (87.9) 4 (12.1)
Significant association at **(p<0.01) or *(p<0.05). #Parents continuously married until follow-up time. ## Parents continuously married until time of first survey.
The results of our cross-sectional study are consistent
with findings from previous cross-sectional studies [3, 7, 9,
14, 15] and prospective studies [5, 12]. A study from Nor-
way has reported that regular smoking and use of illegal
drugs were found to be more common among boys and
girls of divorced parents than their counterparts living with
both biological parents [8]. Our findings show that early
parental divorce continues to have significant impact on
adolescents’ risk behaviors even when divorce rate in re-
cent years is higher than before. For example, the divorce
rate was 17.5 per 1000 married status in 2001 as compared
to only 9.5 per 1000 married couples in the age group 35-
55 in 1984 [30]. Using data collected in 1984/86, a signifi-
cant adverse influence of parental divorce was previously
found in Norway [31].
There is a possibility for an indirect influence on risk
behaviors of experience of parental divorce mediated by
mental health problems. Several studies have found signifi-
cant association between experience of parental divorce
and mental health problems [19, 32, 33], which in turn was
found to be associated with risk behaviors including ciga-
rette smoking, alcohol consumption and illicit substance
use [20]. Stated more precisely, parental divorce increases
the likelihood of risk behaviors by increasing mental health
problems in adolescents [3]. Both of the present study de-
signs also show that mental health problems observed when
the adolescents were 15 /16 year-old were associated with
several risk behaviors. However, we did not find statisti-
cally significant association between experience of late
parental divorce and mental health problems in our previ-
ous prospective study of the same study population [21].
Thus, the non-significant association between late parental
divorce and risk behaviors in our present prospective study
was not unexpected.
Addition al possible explanations for the non-significant
association in our prospective study may be related to the
time of occurrence of parental divorce. Some studies have
reported that risk behaviors among offspring of divorce are
related to the offspring’s age at the time of parental divorce
[34-36]. Whereas elementary school boys who experienced
Parental Divorce and Risk Behaviors Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 63
Table 2. Risk behavior across late parental divorce experienced between 15 and 19 years of age in the prospectively studied sample
of 18/19 year-old adolescents in oslo in 2004 (vertical percentages).
Outcome Variables Categories Frequency (Vertical %)
n = 1861
Continuously Married
n = 1752
Late Divorce
n = 109
Yes 644 (34.6) 598 (34.1) 46 (42.2)
No 1213 (65.2) 1150 (65.6) 63 (57.8)
Cigarette smoking
Missing 4 (0.2) 4 (0.3) 0 (0.0)
Yes 358 (19.2) 339 (19.3) 19 (17.4)
No 1500 (80.6) 1410 (80.5) 90 (82.6)
Snus
Missing 3 (0.2) 3 (0.2) 0 (0.0)
At least once a week 735 (39.5) 691 (39.4) 44 (40.4)
Less than once a week 1101 (59.2) 1037 (59.2) 64 (58.7)
Frequency of drinking
Missing 25 (1.3) 24 (1.4) 1 (0.9)
Yes (used at least once) 142 (7.6) 134 (7.6) 8 (7.3)
Never 1715 (92.2) 1614 (92.1) 101 (92.7)
Doping agents
Missing 4 (0.2) 4 (0.3) 0 (0.0)
Significance level was set at p-value = 0.05 and no statistically significant association was found.
Table 3. Late parental divorce experienced between 15 and 19 years of age (n=109) with change in risk behaviors in a prospective
study of 18/19 year-old adolescents (n=1861) when odds ratios (95% confidence interval) were adjusted in logistic regres-
sions for the same risk behavior, demographic, socio-economic and mental health problem variables observed at the age of
15/16.
Independe nt Variables Smoking Snus Frequent Drinki ng Doping Agents
Crude results
Late parental divorce 1.2 (0.8-1.9) 1.0 (0.6-1.7) 0.9 (0.5-1.4) 0.9 (0.4-2.0)
Adjusted for internalized mental health problems
Late parental divorce (ref=continuously married) 1.2 (0.8-1.9) 1.1 (0.6-1.9) 1.0 (0.6-1.5) 0.9 (0.4-2.0)
Gender (ref=boys) 0.8 (0.6-1.0) 0.2 (0.1-0.3) 0.8 (0.6-1.0) 0.9 (0.6-1.2)
Ethnicity (ref=western) 0.8 (0.6-1.2) 0.4 (0.2-0.6) 0.4 (0.2-0.7) 1.1 (0.7-2.0)
Family economy (ref=average and below) 0.9 (0.7-1.2) 1.6 (1.1-2.3) 1.5 (1.1-2.0) 1.3 (0.9-2.0)
Social support (ref=low) 0.9 (0.6-1.4) 1.2 (0.7-1.9) 1.2 (0.8-1.9) 0.9 (0.5-1.8)
Internalized problems (ref=no) 1.2 (0.9-1.7) 1.7 (1.1-2.5) 0.9 (0.7-1.3) 1.8 (1.1-2.8)
Adjusted for externalized mental health problems
Late parental divorce (ref=continuously married) 1.2 (0.8-2.0) 1.1 (0.6-1.9) 0.9 (0.6-1.5) 1.0 (0.5-2.2)
Gender (ref=boys) 0.8 (0.6-1.0) 0.2 (0.1-0.3) 0.8 (0.6-1.0) 1.0 (0.7-1.5)
Ethnicity (ref=western) 0.8 (0.6-1.1) 0.4 (0.2-0.7) 0.4 (0.3-0.7) 1.3 (0.6-1.9)
Family economy (ref=average and below) 0.9 (0.7-1.2) 1.6 (1.1-2.3) 1.4 (1.1-1.9) 1.3 (0.8-2.1)
Social support (ref=low) 1.0 (0.7-1.5) 1.1 (0.7-1.9) 1.2 (0.8-1.9) 1.0 (0.5-2.0)
Externalized problems (ref=no) 1.6 (1.1-2.3) 1.6 (1.1-2.5) 0.9 (0.6-1.4) 2.1 (1.2-3.4)
64 Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 Zeratsion et al.
Table 4. Early parental divorce experienced when the adolescents were 15/16 year-old or younger (n=530) across risk behaviors in
a cross-sectional study of 15/16 year-old adolescents (n=2422) when odds ratios (95% confidence interval) were adjusted
for demographic, socio-economic and mental health variables.
Independe nt Variables Smoking Snus Fr equent Drinking Doping Agents
Crude results
Early parental divorce 1.4 (1.1-1.7) 1.0 (0.7-1.4) 1.1 (0.8-1.4) 1.7 (1.2-2.3)
Adjusted for internalized mental health problems
Early parental divorce (ref=continuously married)
1.3 (1.1-1.6) 1.0 (0.7-1.4) 1.2 (0.9-1.5) 1.6 (1.2-2.2)
Gender (ref=boys) 1.3 (1.1-1.6) 0.3 (0.2-0.6) 1.2 (0.9-1.5) 1.0 (0.7-1.3)
Ethnicity (ref=western) 0.6 (0.4-0.9) 0.3 (0.1-0.7) 0.7 (0.4-1.2) 0.7 (0.4-1.2)
Family economy (ref=average and below) 1.0 (0.8-1.2) 1.3 (0.9-2.0) 1.9 (1.5-2.5) 1.2 (0.9-1.7)
Social support (ref=low) 0.8 (0.6-1.1) 1.2 (0.7-2.2) 1.1 (0.8-1.7) 0.7 (0.4-1.1)
Internalized problems (ref=no) 2.0 (1.5-2.5) 1.4 (0.8-2.5) 1.7 (1.3-2.2) 2.4 (1.7-3.4)
Adjusted for externalized mental health problems
Early parental divorce (ref=continuously married)
1.3 (1.1-1.6) 1.0 (0.7-1.5) 1.2 (0.9-1.6) 1.6 (1.2-2.3)
Gender (ref=boys) 1.6 (1.3-1.9) 0.4 (0.2-0.7) 1.3 (1.1-1.6) 1.2 (0.9-1.7)
Ethnicity (ref=western) 0.6 (0.4-0.9) 0.3 (0.1-0.7) 0.7 (0.4-1.2) 0.7 (0.4-1.3)
Family economy (ref=average and below) 1.0 (0.8-1.2) 1.4 (0.9-2.1) 1.9 (1.4-2.5) 1.2 (0.9-1.7)
Social support (ref=low) 0.8 (0.6-1.1) 1.3 (0.7-2.4) 1.2 (0.8-1.7) 0.7 (0.5-1.4)
Externalized problems (ref=no) 3.0 (2.3-4.2) 2.4 (1.5-3.8) 2.3 (1.7-3.3) 5.2 (3.6-7.4)
parental divorce were likely to develop problem behaviors
later in their adolescence ages, the effect of parental di-
vorce on adolescents in middle school was found to be less
enduring [34]. Similarly, heavy drinking was found to be
more common among 22 year-old who experienced paren-
tal divorce between age 7 and 12 than among their peers
who had similar experience during their adolescence [35].
The extent of smoking and drinking was higher among 17
year-old adolescents who resided at age 12 in families
where at least one biological parent was not present than
those who lived with both biological parents in their early
adolescence [36]. Even studies conducted a few decades
ago provide evidence that the adverse effects of parental
divorce are larger for children who were very young at the
time of their parents’ marital dissolution than for children
who encounter a relatively late parental divorce [37]. All
these studies indicate that early parental divorce has greater
negative effect than late parental divorce. A possible expla-
natio n cou ld be the fact that key transitional points in th e
lives of young people occur between ages 13 and 14 during
which there is greater tenden cy to begin or increase the
consumption of alcohol, tobacco and illicit drug [38]. A
decrease in parenting effectiveness due to parental absence
following divorce [1] at the critical ages of early adoles-
cence where there is a tendency to begin cigarette smoking ,
drinking and substance use [36] seem to explain the signifi-
cant impact of early parental divorce. Thus, the findings in
our present study might have been to a certain extent influ-
enced by the time of the occurrence of parental divorce in
the lifespan of the offspring.
STRENGTHS AND LIMITATIONS
Data are from a prospective follow-up of a population
with 89% participation at the first survey and a 68% follow-
up rate three years later. Unlike estimates of prevalence, as-
sociation measures are shown to be robust to a loss-to-
follow-up of 32% as in the present study [23]. The divorce
rate in Norway was 5.3% of those in married status over the
follow-up period in the age group 35-55 [30]. Our sample
was representative of Norway because this rate is similar to
the 5.9% computed in our study.
Missing data was more common among non-western than
among western adolescents making our estimates to be more
unsecure for ethnic non-Norwegians. Furthermore, a low rate
of late parental divorce during the three years of follow-up
gives us no indications of divorce being a cause of change in
risk behavior. This low rate gave a small sample size of ado-
lescents with experience of late parental divorce (n=109)
which might have rendered difficulty to discern the signifi-
cance of associations between late parental divorce and risk
behaviors in our prospective study.
We did not have data on the adolescents’ age when di-
vorce occurred. Because of this we could not investigate
association of parental divorce that occurred at different ages
with risk variables at 18/19 years of age.
CONCLUSION
Our prospective study could not show that parental di-
vorce in late adolescence increase risk behavior among 18/19
Parental Divorce and Risk Behaviors Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 65
year-old adolescents. In our cross-sectional study, parental
divorce experienced during childhood or early adolescence is
found to be associated with cigarette smoking and use of
doping agents among 15/16 year-old adolescents.
CONFLICT OF INTEREST
The authors confirm that this article content has no con-
flict of interest.
AUTHORS’ CONTRIBUTIONS
All authors decided design and methods, HZ did the
analysis and wrote the manuscript drafts, all authors read and
approved the final manuscript, and BC supervised the work.
ACKNOWLEDGEMENTS
We thank the National Institute of Public Health for pro-
viding data, and Oslo Municipality for supporting the
Young-HUBRO study.
REFERENCES
[1] Amato PR, Keith B. Parental divorce and the well-being of chil-
dren: a meta-analysis. J Marriage Family 1991; 53: 43-58.
[2] Amato PR. Children of divorce in the 1990s: an update of the
Amato and Keith (1991) meta-analysis. J Fam Psychol 2001; 3:
355-70.
[3] Kirby JB. The influence of parental separation on smoking initia-
tion in adolescents. J Health Soc Behav 2002; 43: 56-71.
[4] Nævdal F, Thuen F. Residence arrangements and well-being: A
study of Norwegian adolescents. Scand J Psychol 2004; 45: 363-
71.
[5] Fergusson DM, Horwood LJ, Lynskey MT. Parental separation,
adolescent psychopathology, and problem behaviors. J Am Acad
Child Adolescent Psychiatry 1994; 33: 1122-33.
[6] Bjarnason T. Andersson B, Choquet M, Elekes Z, Morgan M,
Rapinett G. Alcohol culture, family structure and adolescent alco-
hol use: multilevel modelling of frequency of heavy drinking
among 15-16 year-old students in 11 European countries. J Stud
Alcohol Drugs 2003, 64: 200-8.
[7] Bjarnason T, Davidaviciene AG, Miller P, Nociar A, Pavlakis A,
Sterger E. Family structure and adolescent cigarette smoking in
eleven European countries. Society for the Study of Addiction to
Alcohol and Other Drugs 2003; 98: 815-24.
[8] Breivik K, Olweus D. Children of divorce in a Scandinavian wel-
fare state: are they less affected than US children? Scand J Psychol
2006; 1: 61-74.
[9] Roustit C, Chaix B, Chauvin P. Family breakup and adolescents’
psychosocial maladjustment: public health implications of family
disruptions. Paediatrics 2007; 120: 984-91.
[10] Huurre T, Lintonen T, Kaprio J, Pelkonen M, Marttunen M, Aro H.
Adolescent risk factors for excessive alcohol use at age 32 years: a
16-year prospective follow-up study. Soc Psychiatry Psychiatr
Epidemiol 2010; 1: 125-34.
[11] Needle RH, Su SS, Doherty WJ. Divorce, remarriage and adoles-
cent substance abuse: a prospective longitudinal study. J Marriage
Fam 1990; 52: 157-69.
[12] Doherty WJ, Needle RH. Psychological adjustment and substance
use among adolescents before and after a parental divorce. Child
Dev 1991; 62: 328-37.
[13] Griesbach D, Amos A, Currie C. Adolescent smoking and family
structure in Europe. Soc Sci Med 2003; 56: 41-52.
[14] Thompson RG Jr, Lizardi D, Keyes KM, Hasin DS. Childhood or
adolescent parental divorce/separation, parental history of alcohol
problems, and offspring lifetime alcohol dependence. Drug Alcohol
Depend 2008; 3: 264-9.
[15] Anda RF, Croft J B, Felitti VJ, et al. Adverse childhood experi-
ences and smoking during adolescence and adulthood. JAMA
1999; 282: 1652-58.
[16] Rothman EF, Edwards EM, Heeren T, Hingson RW. Adverse
childhood experiences predict earlier age of drinking onset: results
from a representative US sample of current or former drinkers.
Paediatrics 2008; 2: e298-304.
[17] Kuh D, Maclean M. Women’s childhood experience of parental
separation and their subsequent health and socio-economic status in
adulthood. J Biosoc Sci 1990; 22: 121-35.
[18] Hasin DS, Thompson RG, Lizardi D, and Keyes KM. Childhood or
adolescent parental divorce/separation, parental history of alcohol
problems, and offspring lifetime alcohol dependence. Drug Alcohol
Depend 2008; 98: 264-69.
[19] Størksen I, Røysamb E, Moum T, Tambs K. Adolescents with a
childhood experience of parental divorce: a longitudinal study of
mental health and adjustment. J Adolescence 2005; 28: 725-35.
[20] Kandel BD, Johnson JG, Bird HR, et al. Psychiatric disorders asso-
ciated with substance use among children and adolescents: findings
from the methods for the epidemiology of child and adolescent
mental disorders (MECA) study. J Abnorm Child Psychol 1997;
25: 121-32.
[21] Zeratsion H, Dalsklev M, Bjertness E, et al. Parental divorce in late
adolescence does not seem to increase mental health problems: a
population study from Norway. BMC Public Health 2013; 13: 413.
[22] Hemminki K, Chen B. Lifestyle and cancer: effect of parental
divorce. Eur J Cancer Prev 2006; 6: 524-30.
[23] Bjertness E, Sagatun Å, Green K et al. Response rates and selection
problems, with emphasis on mental health variables and DNA
sampling, in large population-based, cross-sectional and longitudi-
nal studies of adolescents in Norway. BMC Public Health 2010;
10: 602.
[24] Briggs SR, Cheek JM. The role of factor analysis in the develop-
ment and evaluation of personality scales. J Pers 1986; 54: 106-48.
[25] Schraedley PK, Gotlib IH, Hayward C. Gender differences in cor-
relates of depressive symptoms in adolescents. J Adolesc Health
1999; 25: 98-108.
[26] Strand BH, Dalgard OS, Tambs K, Rognerud M. Measuring the
mental health status of the Norwegian population: a comparison of
the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nord
J Psychiatry 2003; 57: 113-8.
[27] Lien L, Haavet OR, Thoresen M, Heyerdahl S, Bjertness E. Mental
health problems, negative life events, perceived pressure and the
frequency of acute infections among adolescents: results from a
cross-sectional, multicultural, population-based study. Acta Pæ-
diatrica 2007; 96: 301-6.
[28] Goodman R. Psychometric properties of the strengths and difficul-
ties questionnaire. J Am Acad Child Adolesc Psychiatry 2001; 40:
1337-45.
[29] Ronning J, Handegaard B, Sourander A, Morch W-T. The strengths
and difficulties self-reported questionnaire as a screening instru-
ment in Norwegian community samples. Eur Child Adolesc Psy-
chiatry 2004; 13: 73.
[30] Statistics Norway. Population statistics: marriage and divorces.
2014. [Cited: 26 May, 2014]. Available from: https://www.ssb.no/
statistikkbanken/selectvarval/Define.asp?subjectcode=&ProductId
=&MainTable=SkilsmissAlder&nvl=&PLanguage=0&nyTmpVar=
true&CMSSubjectArea=befolkning&KortNavnWeb=ekteskap&
StatVariant=&checked=true
[31] Størksen I, Røysamb E, Holmen TL, Tambs K. Adolescent adjust-
ment and well-being: effects of parental divorce and distress. Scand
J Psychol 2006; 47: 75-84.
[32] Fröjd S, Marttunen M, Kaltiala-Heino R. The effect of adolescent-
and parent-induced family transitions in middle adolescence. Nord
J Psychiatry 2011; 64: 1-6.
[33] Huurre T, Junkkari H, Aro H. Long-term psychological effects of
parental divorce: a follow up study from adolescence to adulthood.
Eur Arch Psychiatry Clin Neurosci 2006; 256: 256-63.
[34] Malone PS, Lansford JE, Castellino DR, et al. Divorce and child
behavior problems: applying latent change score models to life
event data. Struct Equ Modeling 2004; 11(3): 401-23.
66 Clinical Practice & Epidemiology in Mental Health, 2014, Volume 10 Zeratsion et al.
[35] Palosaari U, Aro H. Effect of timing of parental divorce on the
vulnerability of children to depression in young adulthood. Adoles-
cence 1999; 29(115): 681-91.
[36] McVie S and Holmes L. Family functioning and substance use at
ages 12 to 17. The Edinburg Study of Youth Transitions and Crime
2005; 9: 1-35.
[37] Allison PD, Furstenberg FF. How marital dissolution affects chil-
dren: variations by age and sex. Dev Psychol 1989; 25(4): 540-9.
[38] McVie S, Bradshaw P. Adolescent smoking, drinking and drug use.
The Edinburg Study of Youth Transitions and Crime 2005; 7: 1-44.
Received: February 26, 2014 Revised: May 28, 2014 Accepted: June 02, 2014
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